Lock In 2011 Online Registration
You must enter an email address to register if not the registration will not send.
For students grades 6 - 9

Click here for Directions

Cost: $10 if registered by November 28th.
$15 at the door.
Pre-registration is complete when your
payment has been made.

Church Office: (304) 776-3154

Do You Know Jesus?

Name:

Address:

City:

State:

Code:

Your Phone:

*(Required) Email:

School:

Grade:

Do you attend church?

Yes No

Who invited you?

If yes, what church?

Emergency Contact Name:

Emergency Contact Number: